| NPI | 1063422566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME0053077) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0053077) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2026-05-21 |