| NPI | 1467574467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35095391) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2009004288) |
| 208600000X Surgery (Licence: MO 2009004288) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-10-23 |