| NPI | 1053572396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA a122353) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116017414) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 53496) | |
| 208200000X Plastic Surgery (Licence: CA a122353) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2014-10-24 |