| NPI | 1245767383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: GA 95856) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301502978) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301112579) | |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2024-08-19 |