| NPI | 1366963340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037550) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 7452851) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2023-06-20 |