| NPI | 1902001704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OT012059) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL OS13826) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2026-01-26 |