| NPI | 1700072022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CO 0055035) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A96305) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2021-06-18 |