| NPI | 1275607160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A32832) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A32832) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-12-08 |