| NPI | 1316383391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME155111) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A192179) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2026-07-10 |