| NPI | 1770978025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: NJ 25MB11178700) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-09-30 |