| NPI | 1164678959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX P5893) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX P5893) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2023-03-06 |