| NPI | 1295818201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101245829) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL24528) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101245829) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-06-28 |