| NPI | 1821358862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 66305) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A155488) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2020-06-16 |