| NPI | 1629568845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX V1573) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-06-18 |