| NPI | 1487233805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: VA 0110009393) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-04 |
| Last Update Date | 2024-08-30 |