| NPI | 1225327224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35134415) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 8415687-1205) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 8415687-1205) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2018-08-14 |