| NPI | 1548559222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A179266) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: CA A179266) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2022-09-27 |