| NPI | 1518385004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A179481) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 62601) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2025-08-26 |