| NPI | 1336194935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WV 18744) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 81842) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2013-05-10 |