| NPI | 1316262603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OR MD183197) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA 1316262603) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2022-02-04 |