| NPI | 1780188896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 322215) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NJ 25MA11788000) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64001) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2023-07-31 |