| NPI | 1043830383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2025-03814) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MT MED-PHYS-LIC-167258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2026-06-09 |