| NPI | 1942695424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2022027131) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A171959) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2023-02-24 |