| NPI | 1316911571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD00032850) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ID M6830) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2022-01-25 |