| NPI | 1447547955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD.MD.60838615) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098832) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2018-06-11 |