| NPI | 1255421483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX J5674) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA C52028) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2021-12-29 |