| NPI | 1861011736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.249905) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A209162) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: CA A209162) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2026-05-31 |