| NPI | 1750819868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301509749) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME156683) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2023-11-20 |