| NPI | 1740506120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX F5636) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NV 5405) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX F5636) | |
| 208200000X Plastic Surgery (Licence: FL 115187) | |
| Enumeration Date | 2010-04-11 |
| Last Update Date | 2026-04-16 |