| NPI | 1043639495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA 322082) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 65887) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 00852300) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-04-07 |