NPI | 1275030488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MA 1020335) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-04-12 |
Last Update Date | 2024-06-03 |