| NPI | 1528105889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 40375) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1344) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IA 40375) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-08-01 |