| NPI | 1114450277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 310859) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 377877266) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2022-06-17 |