| NPI | 1790911972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN MD0000055433) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301108131) |
| 208200000X Plastic Surgery (Licence: TN MD0000055433) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2017-05-03 |