| NPI | 1881890119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME111781) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 259801) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2021-04-02 |