| NPI | 1407380546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S8729) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A178223) |
| Enumeration Date | 2017-04-15 |
| Last Update Date | 2023-01-03 |