| NPI | 1235793266 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA12598500)  | 
| Additional Taxonomies | 207YS0012X Otolaryngology, Sleep Medicine (Licence: PA MT218569)  | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-25 | 
| Last Update Date | 2025-06-16 |