| NPI | 1013574839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 97677) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: SC LL82570) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2026-09-24 |