| NPI | 1548505100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: OH 35.139887) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 207Y00000X) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MN 65246) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2020-07-01 |