| NPI | 1184884116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A104654) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA PENDING) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2021-07-02 |