| NPI | 1033598248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037514) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 1033598248) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2023-07-14 |