| NPI | 1891780755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 18443) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35061196M) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2008-09-17 |