| NPI | 1063972891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX 1063972891) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX 1063972891) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-03-27 |