| NPI | 1851604573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX R0023) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57017666) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2021-03-26 |