| NPI | 1518209980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME151813) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.136201) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2022-06-08 |