| NPI | 1255588810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 122373) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 112600) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2020-12-11 |