| NPI | 1275794752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX Q0955) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME115036) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2016-10-18 |