| NPI | 1134689144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME175499) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC MMD.92911) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-09-15 |