| NPI | 1194761833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO DR.0054039) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00046553) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00046553) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2019-10-30 |