| NPI | 1659305985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD418848) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.088899) |
| 208200000X Plastic Surgery (Licence: CT 042585) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-01-07 |