| NPI | 1417150624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 43310) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082558) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301082558) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2015-12-15 |