| NPI | 1245645589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA 60961766) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 60961766) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2020-10-15 |