| NPI | 1649407347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NV 17614) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D71549) |
| 208600000X Surgery (Licence: MA 241160) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10044391) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2018-07-02 |