| NPI | 1952564023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX R3506) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT193364) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193364) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2019-12-17 |