| NPI | 1790218097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: GA 91166) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 91166) |
| 207Y00000X Otolaryngology (Licence: DC MD210001410) | |
| 207Y00000X Otolaryngology (Licence: MD D96684) | |
| 207Y00000X Otolaryngology (Licence: VA 0101277568) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2023-05-11 |