| NPI | 1568996056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A163351) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 00000000000000000000) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2019-10-04 |