| NPI | 1003182395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A129081) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2015-09-03 |