| NPI | 1851504666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 70028) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WV 24020) |
| 208200000X Plastic Surgery (Licence: FL 126249) | |
| 208600000X Surgery (Licence: MI 4301080598) | |
| 208200000X Plastic Surgery (Licence: OH 35.129307) | |
| 208200000X Plastic Surgery (Licence: MI 4301080598) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-08-17 |