| NPI | 1528403888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 49515) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AZ R73739) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 291937) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2020-09-30 |