| NPI | 1346545837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 12054791-1205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 12054791-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2021-10-27 |