| NPI | 1356857528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 73673) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA 188879) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-12-23 |
| Last Update Date | 2025-06-11 |