| NPI | 1518462589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A163479) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 3013602) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-09-23 |