| NPI | 1780143503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD488807) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-11-11 |