| NPI | 1639411929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 312269) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN MD0000057103) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2021-04-20 |