| NPI | 1508488149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4351055117) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT220439) |
| Enumeration Date | 2020-05-16 |
| Last Update Date | 2025-06-15 |