| NPI | 1689201634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A186870) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA PTL4233) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-07-01 |