| NPI | 1487091328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 294203) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG168015) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116025714) | |
| Enumeration Date | 2013-06-02 |
| Last Update Date | 2026-02-15 |