| NPI | 1912095100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MS 139170) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IA MD-56319) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2026-01-19 |