| NPI | 1184715245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 295485) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G083294) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-03-13 |