| NPI | 1194103598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2023-02157) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A176353) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107161) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-08-10 |