| NPI | 1598979064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2025-03373) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016660) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MS 21004) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-12-02 |