| NPI | 1952628406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 304196) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 304196-01) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301112018) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2020-11-02 |