| NPI | 1720198112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.051583) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME84583) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-10-01 |