| NPI | 1699118638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 311822) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY PENDING) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 255415) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2021-08-06 |