| NPI | 1790191047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045888) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2014018072) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2020-07-28 |