| NPI | 1619402294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX U9365) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 85409) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-08-28 |