| NPI | 1497101794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A151704) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A151704) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CA A151704) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CA A151704) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-07-11 |