| NPI | 1306247812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PR 22921) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 69904) |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: PR 22921) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 4927717) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2022-10-20 |