| NPI | 1689802704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 88707) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35134127) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2022-11-15 |