| NPI | 1184074536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.245062) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101274982) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2022-08-19 |