| NPI | 1508185984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 139862) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208200000X Plastic Surgery (Licence: KY R2415) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2016-08-05 |