| NPI | 1851369714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-056534) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35-056534) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2011-03-14 |