| NPI | 1588816961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO DR.0070716) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD456013) |
| 208200000X Plastic Surgery (Licence: CA A115470) | |
| 208600000X Surgery (Licence: NY 245008) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX S1195) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 245008) | |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2023-09-01 |