| NPI | 1619916335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35084144) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 43734) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-09-20 |