| NPI | 1023165768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00019791) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA MD00019791) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: WA MD00019791) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-05-02 |