| NPI | 1699903971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35123185) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301094532) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2021-02-18 |