| NPI | 1831415843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 57.018202) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 284043) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2021-01-12 |