| NPI | 1386264810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A178403) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA PTL5002) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2022-07-27 |