| NPI | 1780245803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4351045676) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4351045676) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-02-07 |