| NPI | 1356832539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME160767) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AZ R77057) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2023-07-27 |