| NPI | 1235455833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.120373) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KY 47935) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2020-10-23 |