| NPI | 1043697618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-157876) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 85540) |
| 208600000X Surgery (Licence: WI 76254) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-02 |
| Last Update Date | 2022-03-02 |