| NPI | 1891019428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OR MD182026) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA MD60292214) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2018-03-02 |