| NPI | 1619362795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IL 036157688) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 60856) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 60856) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63652) | |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2021-10-28 |