| NPI | 1316435035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 202502072) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.245637) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2026-04-30 |