| NPI | 1659928208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 76941) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 76941-20) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-06-11 |