| NPI | 1174903397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 80.000072) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 263399) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 263399) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-06-03 |