| NPI | 1376931105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.043691) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 16223) |
| 208200000X Plastic Surgery (Licence: FL ME 86453) | |
| Enumeration Date | 2015-01-01 |
| Last Update Date | 2015-01-01 |