| NPI | 1528202553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 246683) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A99314) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2021-11-30 |