| NPI | 1063973972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2025029856) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT231592) |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: PA MT231592) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-08-07 |