| NPI | 1154407617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101055334) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35096601) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2019-08-09 |