| NPI | 1508329137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301511600) |
| Additional Taxonomies | 207YX0901X Otolaryngology Otology & Neurotology (Licence: MI 4301511600) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-06-28 |