| NPI | 1336553361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AR E-19002) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL37201) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL19-0635) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2025-06-20 |