| NPI | 1982874657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A101736) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD423349) |
| Enumeration Date | 2008-03-09 |
| Last Update Date | 2022-02-11 |