| NPI | 1609254358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX v7798) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT208318) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2025-07-08 |