| NPI | 1982771044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 34.011639) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 2441) |
| 208600000X Surgery (Licence: WV 2441) | |
| 208600000X Surgery (Licence: OH 34.011639) | |
| 208600000X Surgery (Licence: PA OS011852) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA OS011852) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-06-22 |