| NPI | 1588041982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME153962) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD205749) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2025-08-20 |