| NPI | 1669145629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 005322) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 5322) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2022-09-28 |