| NPI | 1245557172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: SC 51469) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: SC 51469) |
| 208200000X Plastic Surgery (Licence: PA MD457869) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2022-02-01 |