| NPI | 1922508530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: WA OP70030704) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA OP70030704) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2026-03-30 |