| NPI | 1801000906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 22625) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 64608) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2021-05-07 |