| NPI | 1821144429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A107632) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO DR-49903) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1327) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-12-01 |