| NPI | 1831160803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 81640) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301089325) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-10-18 |