| NPI | 1326542192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX V3834) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS022535) |
| 208600000X Surgery (Licence: PA OS022535) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-03-23 |