| NPI | 1982138111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A157466) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX V9707) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2026-08-27 |