| NPI | 1912196650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: HI MD-17248) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A95642) |
| 208200000X Plastic Surgery (Licence: NC 180529) | |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2013-10-28 |