| NPI | 1922259159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A122677) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A122677) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2025-08-15 |