| NPI | 1194187807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 87897) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208200000X Plastic Surgery (Licence: TX V6998) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-10-16 |