| NPI | 1720304215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A117723) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL Student) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2020-05-29 |