| NPI | 1821146770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD00049238) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A82206) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-07-29 |