| NPI | 1508156928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101272945) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 11250305-1205) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD465033) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2024-07-02 |