| NPI | 1255774725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PR 21271) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.131784) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R9739) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-06-01 |