| NPI | 1376672030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD451341) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD451341) |
| 208600000X Surgery (Licence: OH 35.097930) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2019-12-03 |