| NPI | 1053754218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CT 62583) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 62583) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA12125800) | |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: NJ 25MA12125800) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2024-04-09 |