| NPI | 1275548695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35144123) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D47480) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101245217) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-04-19 |