| NPI | 1548203623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35040615) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 30840) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2011-11-01 |