| NPI | 1003997123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35-090312) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 45597-020) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-12-27 |