| NPI | 1720346844 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MT 60848) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA MD-44083) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2018-06-01 |