| NPI | 1093766040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME168028) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301083297) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-04-26 |