| NPI | 1124287370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101245999) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101245999) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2022-06-10 |