| NPI | 1053200964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301513957) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI MD4301513957) |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-08-13 |