| NPI | 1558637975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME152206) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101254433) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2022-06-09 |