| NPI | 1972935583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 76540) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A195410) |
| 183500000X Pharmacist (Licence: MN 121293) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2026-01-12 |