| NPI | 1811317290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX S8863) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX S8863) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2022-07-07 |