| NPI | 1487834792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OR MD181033) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD27893) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.123545) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2017-03-07 |