| NPI | 1619130333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301091967) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD489650) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PA MD489650) | |
| 208600000X Surgery (Licence: MI 4301091967) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301091967) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2025-06-20 |