| NPI | 1831346535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AR E-8278) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301074217) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2014-03-05 |