| NPI | 1326432998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX T6924) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI K632615352549) |
| Enumeration Date | 2015-03-22 |
| Last Update Date | 2025-05-15 |