| NPI | 1649624925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD61260024) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MT MED-PHYS-LIC-127424) |
| 208200000X Plastic Surgery (Licence: UT 10516770-1205) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD61260024) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-06-19 |