| NPI | 1750469896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A109264) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NH RT 1250) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-02-11 |