| NPI | 1447630199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 314856) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX S9341) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107909) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-07-28 |