| NPI | 1114264637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 012856) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 9407635) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2022-07-21 |