| NPI | 1265647150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.129955) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301079544) |
| 208200000X Plastic Surgery (Licence: OH 35.129955) | |
| 208600000X Surgery (Licence: MI 4301079544) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301079544) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 249477) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-08-25 |