| NPI | 1750369450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: WA MD00021808) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA MD00021808) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2019-04-12 |