| NPI | 1922597913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME166178) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042167) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN28909) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2024-07-14 |