| NPI | 1083111645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: SC 91595) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-04-22 |