| NPI | 1326185612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60273505) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2144) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-04-29 |