| NPI | 1346774692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 77616) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX T5578) |
| 207Y00000X Otolaryngology (Licence: TX 25425) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-07-12 |