| NPI | 1225417728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO DR.0075229) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60801198) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60561734) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009431) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2025-04-29 |