| NPI | 1225569106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-02000) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME153868) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-08-03 |