| NPI | 1386614741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.130264) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.130264) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2025-09-15 |