| NPI | 1871989624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CT 75126) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A177541) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A177541) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2023-06-14 |