| NPI | 1508128125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.149124) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101254446) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-10 |
| Last Update Date | 2024-08-20 |