| NPI | 1104246339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A142610) |
| Additional Taxonomies | 2082S0105X Plastic Surgery Surgery of the Hand (Licence: CA A142610) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: CA A142610) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2021-07-27 |