| NPI | 1780746115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NM MD2014-0746) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A94477) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2023-07-21 |