| NPI | 1235611005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD473596) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: PA MD473596) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2022-12-01 |