| NPI | 1891108759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 5101021136) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021136) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2025-11-25 |