| NPI | 1821357419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 288151-1) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 288151) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2024-04-03 |