| NPI | 1295049070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX Q4085) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q4085) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57. 025880) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2021-10-13 |