| NPI | 1679100697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2026-01745) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2026-01745) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-08-05 |