| NPI | 1306056676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A135204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL16534) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-01-03 |