| NPI | 1235791005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX V8262) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4351045673) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2025-07-03 |