| NPI | 1376704353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 62675) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 268657) |
| 208200000X Plastic Surgery (Licence: CT 62675) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-22 |
| Last Update Date | 2022-09-13 |