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 |