| NPI | 1164520938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G154846) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301066217) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-05-18 |