| NPI | 1326493461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 58920) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: KY 51853) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY FT556) | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2023-05-10 |