| NPI | 1104938893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60986017) |
| Additional Taxonomies | 163WS0121X Registered Nurse, Plastic Surgery (Licence: VA 0101263196) |
| 208200000X Plastic Surgery (Licence: OR MD24934) | |
| 208200000X Plastic Surgery (Licence: FL ME99859) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-06-08 |