| NPI | 1063900645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA 335669) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301114534) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2023-05-19 |