| NPI | 1235698432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A179171) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A179171) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-09-21 |