| NPI | 1609227214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: GA 103760) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 2022-00508) |
| 208200000X Plastic Surgery (Licence: IL 125.068724) | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2025-08-12 |