| NPI | 1609210525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61689910) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MT 67068) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2026-01-07 |