| NPI | 1164684643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 7343869-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016535) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2009-06-18 |