| NPI | 1356432959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AZ 63115) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX L9883) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2026-07-14 |