| NPI | 1033300025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35130448) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP1-0029123) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2018-08-09 |