| NPI | 1063951689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NM DO2022-0077) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: MI 5101023512) |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: MI 5315087403) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2023-03-11 |