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 |