| NPI | 1346478633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301094280) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 4301094280) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-05-26 |