| NPI | 1598867038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD61266495) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX R1785) |
| 208200000X Plastic Surgery (Licence: CO DR.0063783) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2026-02-17 |