| NPI | 1649702150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4351048917) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KS 04-050630) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-04-17 |