| NPI | 1942380787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G076688) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL 131200) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-07-21 |