| NPI | 1962815191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 080595) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 61020) |
| 207Y00000X Otolaryngology (Licence: PA MD474008) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105770) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2025-06-17 |