| NPI | 1871074310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: UT 10948626-1206) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2021-10-21 |