| NPI | 1457476079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G0436338) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G46338) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-10-30 |