| NPI | 1528092012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35-04-3030) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35-04-3030) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-10-12 |