| NPI | 1477085686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2024-00861) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208200000X Plastic Surgery (Licence: TX U4941) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-09-25 |