| NPI | 1891086799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MD D0080586) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101259510) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2019-07-30 |