| NPI | 1740629906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: IA DO-05180) |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: IL 036145258) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2020-09-15 |