| NPI | 1366762643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 284837) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 284837) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-05-05 |