| NPI | 1104029693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.146320) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301090323) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2026-03-13 |