| NPI | 1780144386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX V6863) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: GA 111677) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-05-20 |