| NPI | 1720817836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY R7609) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R7609) |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2026-10-08 |