| NPI | 1437534682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 63540) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 63540) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.025819) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2025-01-23 |