| NPI | 1073045654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME160393) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 87733) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2023-07-30 |