| NPI | 1710112024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA OS017194) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL OS12098) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-16 |
| Last Update Date | 2020-08-26 |