| NPI | 1952891871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: GA 95295) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 95295) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-08-20 |