| NPI | 1255759320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD61201614) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A139547) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-12-05 |