| NPI | 1699093104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A118700) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301106768) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2021-12-06 |