| NPI | 1093785404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX H7994) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 34005727) |
| 207Q00000X Family Medicine (Licence: TX H7994) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2016-09-02 |