| NPI | 1407207145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 291776) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110334) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2022-06-22 |