| NPI | 1558867846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 69905) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.141049) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2021-08-03 |