| NPI | 1477547503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35083016) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME93650) |
| Enumeration Date | 2005-09-05 |
| Last Update Date | 2019-04-05 |