| NPI | 1942255088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 265020) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD-070187-L) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2025-01-22 |