| NPI | 1992883847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00023270) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00023270) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-01-06 |