| NPI | 1841721826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KS 04-51431) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 315883) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2025-08-01 |