| NPI | 1568842086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 20A18846) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MN 60904) |
| 208200000X Plastic Surgery (Licence: WI 103935) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2026-07-10 |