| NPI | 1487095527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: PA OS019971) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 080410) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2019-06-12 |