| NPI | 1336583350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD61064481) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35135868) |
| 208200000X Plastic Surgery (Licence: KY R3352) | |
| Enumeration Date | 2013-04-21 |
| Last Update Date | 2020-07-30 |