| NPI | 1306263322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60661486) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60661486) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2022-04-28 |