| NPI | 1578919692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 20A23635) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA OS026322) |
| Enumeration Date | 2016-05-07 |
| Last Update Date | 2026-08-18 |