| NPI | 1578056966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2025-00982) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 036.169754) |
| 208200000X Plastic Surgery (Licence: NC 2025-00982) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 036169754) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2025-07-03 |