| NPI | 1669629432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MO 2012011177) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.092323) |
| 208200000X Plastic Surgery (Licence: NY 2443861) | |
| 208200000X Plastic Surgery (Licence: IL 036111057) | |
| 208600000X Surgery (Licence: OH 35092323) | |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2013-02-05 |