| NPI | 1346744554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.155219) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.155219) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2026-03-30 |