| NPI | 1588956064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: LA MD.206623) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2018-08-17 |