| NPI | 1023384773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL 145407) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A160502) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2026-04-01 |