| NPI | 1992168751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101285810) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 12744875-1205) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2025-07-31 |