| NPI | 1316260797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.131569) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD456615) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2023-11-03 |