| NPI | 1053486977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N6213) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A91039) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2021-12-10 |