| NPI | 1578068805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX W0548) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: TX W0548) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2025-08-26 |