| NPI | 1770100133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 69993) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 30866) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX W5759) | |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2026-07-16 |