| NPI | 1659716645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: VA 0116036049) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R3390) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2021-09-29 |