| NPI | 1649433368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: HI MD-21944) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 284660-1) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301091948) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301091948) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2021-10-27 |