| NPI | 1649271222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35-072442) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35-072442) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-04-21 |