NPI | 1154718179 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 10092126-1205) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-04-16 |
Last Update Date | 2021-08-18 |