| NPI | 1801009436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101247630) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016420) |
| 207Y00000X Otolaryngology (Licence: IA 38596) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: IA 38596) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-07-07 |