| NPI | 1376993345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.145218) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 57.028311) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-08-12 |