| NPI | 1801185863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: DC MD045349) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 55183) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2020-11-30 |