| NPI | 1235113408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35-042744) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.042744) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2013-08-30 |