| NPI | 1295995405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 204776) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 204776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2018-03-17 |