| NPI | 1528180544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A052955) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A052955) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-03-06 |