| NPI | 1467795575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A170617) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MT MED-PHYS-LIC-117418) |
| 208600000X Surgery (Licence: KY 51129) | |
| 208600000X Surgery (Licence: CA A170617) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2025-04-28 |