| NPI | 1619312956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 306655) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 82147) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2020-09-03 |