| NPI | 1003366808 |
|---|---|
| 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: OR MD208155) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2022-05-23 |