| NPI | 1013361005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2023034779) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KS 04-48159) |
| 207Y00000X Otolaryngology (Licence: CA A178079) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CA 178079) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2024-08-26 |