| NPI | 1376525188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 34-00-5512-B) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34-00-5512-B) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2020-12-28 |