| NPI | 1699063057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35132372) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY TP734) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2022-11-29 |