| NPI | 1629633888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX V7183) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 99950) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2025-06-30 |