| NPI | 1407390339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX T7272) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: MO 2019007499) | |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2022-09-14 |