| NPI | 1649567769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35-133804) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35-133804) |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2022-03-01 |