| NPI | 1740608942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A169149) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A169149) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2026-07-28 |