| NPI | 1528591849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 322602-01) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY R4474) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2023-05-15 |