| NPI | 1699939249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 278963) |
| Additional Taxonomies | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: SC 35832) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193549) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2018-03-16 |