| NPI | 1710478573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WI 73015-20) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.150824) |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2025-08-28 |