| NPI | 1033776349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD489248) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 62111) |
| 208200000X Plastic Surgery (Licence: RI LP04563) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2026-07-31 |