| NPI | 1568881282 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX T5085) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME169949) |
| 208600000X Surgery (Licence: AR E-15020) | |
| 208600000X Surgery (Licence: FL TRN27888) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2025-02-14 |