| NPI | 1427314939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PA MD472504) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: OH 35131723) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2020-12-18 |