| NPI | 1376704346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX Q9487) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 236903) |
| 208200000X Plastic Surgery (Licence: MI 4301094368) | |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: TX Q9487) | |
| Enumeration Date | 2008-06-22 |
| Last Update Date | 2016-08-03 |