| NPI | 1841677192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 309895) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 80024) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2025-03-24 |