| NPI | 1164801411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 7205671-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OR MD197082) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107292) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2023-06-15 |