| NPI | 1053498949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35085059) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35-085059) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-08-30 |