| NPI | 1154570042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME 92518) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME92518) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2018-07-22 |