| NPI | 1386962561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME137032) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35128432) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35128432) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2019-03-18 |