| NPI | 1932769270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA 351623) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 1022175) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 57.248112) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-08-07 |