NPI | 1114339942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA 169091) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-05-28 |
Last Update Date | 2020-11-20 |