| NPI | 1861784449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL OS21708) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IN 02005587A) |
| 208600000X Surgery (Licence: MI 5101019137) | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2026-03-26 |