| NPI | 1801155064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL me173641) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 62006) |
| 208200000X Plastic Surgery (Licence: UT 13930346-1205) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2025-06-06 |