| NPI | 1356831978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351051027) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 9133) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2023-08-08 |