| NPI | 1174692784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2018-02877) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME112626) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101231511) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2026-05-27 |