| NPI | 1386864288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35095444) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 238592) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2011-09-16 |