| NPI | 1043509227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 280821-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 280821-1) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0058741) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2020-07-19 |