| NPI | 1578614103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A60220) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A60220) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2025-03-07 |