| NPI | 1629463229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: DC MD500003476) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101272077) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2026-09-09 |