| NPI | 1013671981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.153098) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 125.078374) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2025-04-30 |