| NPI | 1174970198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2024-03284) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN# 19647) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2025-06-24 |