| NPI | 1992744841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35057977) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 30748) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |