| NPI | 1871751412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MS 23630) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WI 1761) |
| 207Y00000X Otolaryngology (Licence: ND PT13586) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-05-20 |