| NPI | 1780038612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 81425) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX v0227) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2025-06-24 |