NPI | 1255708731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD61119552) |
Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD61119552) |
Enumeration Date | 2015-08-31 |
Last Update Date | 2021-05-05 |