| NPI | 1871013912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.151183) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.151183) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-11-12 |