| NPI | 1992951412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: KY 52047) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35099787) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2019-03-23 |