| NPI | 1588919617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60925851) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 57) |
| Enumeration Date | 2012-07-15 |
| Last Update Date | 2026-03-02 |