| NPI | 1578763496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX M6054) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX M6054) |
| 208200000X Plastic Surgery (Licence: OH 35091519) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2022-03-16 |