| NPI | 1871640680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AZ 48996) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 43896) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2026-05-04 |