| NPI | 1245464387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 48376) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY R2110) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2019-10-16 |