| NPI | 1114597002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OK 39651) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: OK 39651) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2022-06-08 |