| NPI | 1548286727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35-061505) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301049252) |
| 208200000X Plastic Surgery (Licence: NJ 25MA05329900) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |