| NPI | 1053451518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A-121399) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A121399) |
| 208600000X Surgery (Licence: OK 24625) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-12-20 |