| NPI | 1154826477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX V3368) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Y00000X Otolaryngology (Licence: MN 73596) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-10-09 |