| NPI | 1952834012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.150965) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 1014257) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2024-06-25 |