| NPI | 1982970513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60470774) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA ML60286024) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2020-12-08 |