| NPI | 1356841977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 1022431) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 6116510) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2025-05-28 |