| NPI | 1720764053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2023020875) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2023020875) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-06-22 |