| NPI | 1922003219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 35085183) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WV 20854) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-01-10 |