| NPI | 1902929219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 42124) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35.113919) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AL 23570) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2022-07-07 |