| NPI | 1932562402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 42538) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Y00000X Otolaryngology (Licence: OH 57.028400) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2021-05-28 |