| NPI | 1508997032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301030689) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WY 2735A) |
| 208200000X Plastic Surgery (Licence: NC 30028) | |
| 208200000X Plastic Surgery (Licence: PA MD430264) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2026-07-13 |