| NPI | 1831577253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX W7254) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10053999) |
| 208200000X Plastic Surgery (Licence: MD D91840) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2026-08-28 |