| NPI | 1023455169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MS 26630) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AZ 49529) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R73740) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-09-03 |