| NPI | 1598867038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101239663) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101239663) |
| 208200000X Plastic Surgery (Licence: WA MD61266495) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MD D79127) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: VA 0101239663) | |
| 208600000X Surgery (Licence: VA 0101239663) | |
| 208600000X Surgery (Licence: MD D79127) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D79127) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2022-07-26 |