| NPI | 1518084904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA C51707) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NV 7102) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2010-02-15 |