| NPI | 1831305382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.096360) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX P2331) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2021-04-05 |