| NPI | 1275622052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA C55208) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NE 193) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-02-21 |