| NPI | 1578761128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 310853) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD439929) |
| 208200000X Plastic Surgery (Licence: OH 35123880) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2023-03-27 |