| NPI | 1063625093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60146241) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A93601) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-05-12 |