| NPI | 1558821108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 14231097-1205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 125.074941) |
| 208200000X Plastic Surgery (Licence: UT 14231097-1205) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-07-25 |