| NPI | 1184895146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CO 0056508) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT188778) |
| 208200000X Plastic Surgery (Licence: OH 35098881) | |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2021-05-04 |