| NPI | 1265691158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R7662) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 27188) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2018-08-25 |