| NPI | 1043209687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WV 17547) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD040888E) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2025-01-16 |