| NPI | 1194172106 |
|---|---|
| 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: NY 322840) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2026-06-10 |