| NPI | 1356601280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182297) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 182297) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2021-02-16 |