| NPI | 1740452317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.126384) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA L250881) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 250881) | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2018-03-09 |