| NPI | 1639290075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA C156516) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 57899) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 22324) | |
| 208200000X Plastic Surgery (Licence: FL 164717) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-09-15 |