| NPI | 1750516324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX q9159) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35126915) |
| 208600000X Surgery (Licence: PA MT195131) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2023-03-01 |