| NPI | 1760800742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME145871) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 58853) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2023-04-23 |