| NPI | 1497040265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A134283) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-6090) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL MD-36195) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2021-05-26 |