| NPI | 1124557830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA OS023507) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS023507) |
| 208600000X Surgery (Licence: IA R-10855) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2025-07-24 |