| NPI | 1548463300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101256477) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101256477) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019221) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-08-09 |