| NPI | 1649616012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CO DR.0060639) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301102643) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2019-08-16 |