| NPI | 1902669559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA PA64220) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA64220) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2026-03-18 |