| NPI | 1053503672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX Q799) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME111007) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2025-11-10 |