| NPI | 1013205731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WV 35505) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA 481008) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2026-09-09 |