| NPI | 1780883819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD447700) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 67244) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2025-03-07 |