| NPI | 1487129367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME163948) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IA MD-56473) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2026-01-27 |