| NPI | 1437170933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G40871) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA GO4871) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-07-14 |