| NPI | 1821557661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 250013) |
| 208600000X Surgery (Licence: GA 100439) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 100439) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-07-15 |