| NPI | 1467604058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A113560) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX TMBPIT#BP10032309) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2015-07-13 |