| NPI | 1770013690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 14031532-1205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD481365) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2024-06-17 |