| NPI | 1699794685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 33754) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 73700) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-07-16 |