| NPI | 1578941159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NM MD2023-1061) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A149021) |
| 208600000X Surgery (Licence: PA MT208797) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2023-07-12 |