| NPI | 1003220948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: ND 23259) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7238) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2026-02-06 |