| NPI | 1336385137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.047907) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME63528) |
| 208200000X Plastic Surgery (Licence: FL ME63528) | |
| 208600000X Surgery (Licence: FL ME03528) | |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2021-03-12 |