| NPI | 1699781724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35062878) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-062878) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-11-30 |