| NPI | 1104407980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4351049935) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301516607) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2026-05-12 |