| NPI | 1699906164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60107020) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: WA MD 60107020) |
| 208200000X Plastic Surgery (Licence: WA MD 60107020) | |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: WA MD 60107020) | |
| Enumeration Date | 2009-08-01 |
| Last Update Date | 2017-06-26 |