| NPI | 1720511363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: WA MD61392027) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 291924) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2024-01-05 |