| NPI | 1114718236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 36324) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 45623) |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2026-05-18 |