| NPI | 1770022774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX U6232) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX U6232) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2026-07-21 |