| NPI | 1710985049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.A10629) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA LA10629) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2024-11-13 |