| NPI | 1619316783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A158793) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2013020089) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-11-17 |