| NPI | 1033116785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA 042289e) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.135166) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-10-03 |