| NPI | 1629393319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 66232) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD455747) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2023-01-18 |