| NPI | 1982139176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.154811) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 95455) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2026-01-13 |