| NPI | 1053773648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VT 042-0016201) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 338822) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-07-24 |