| NPI | 1487755708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D68655) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD492146) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2026-07-28 |