| NPI | 1083737738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60974739) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 8911101-1205) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 8911101-1205) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2021-09-14 |