| NPI | 1205499977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX W3900) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 30843) |
| 208200000X Plastic Surgery (Licence: MN 69696) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2026-07-17 |