| NPI | 1508895699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A104687) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 50836-020) |
| 208200000X Plastic Surgery (Licence: PA 420368) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2023-02-07 |