| NPI | 1558496117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2022-03010) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101244179) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 38652) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2023-08-16 |