| NPI | 1568429231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G61493) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA 00034318) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2016-11-22 |