| NPI | 1578767653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D79491) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8644) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-06-02 |