| NPI | 1043674708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MD D0090587) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63718) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2021-08-25 |