| NPI | 1982128658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.144420) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11021449A) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2022-05-03 |