| NPI | 1861814592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 109148) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 073930) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2022-12-15 |