| NPI | 1801359500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD.MD.61662154) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME166778) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2020-03718) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-08-13 |