| NPI | 1053458331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX bp10029129) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2154) |
| 208200000X Plastic Surgery (Licence: TX N9390) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-06-22 |