| NPI | 1366881773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A-178104) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.146239) |
| 208200000X Plastic Surgery (Licence: LA 313047) | |
| 208600000X Surgery (Licence: PA MT205017) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2024-04-09 |