| NPI | 1487218319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA12685400) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 35.150317) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-08-04 |