| NPI | 1144648627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NM NM2021-0692) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 11784145-1205) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2026-02-17 |