NPI | 1063123016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 68111) |
Additional Taxonomies | 208600000X Surgery (Licence: PA 478246) |
Enumeration Date | 2022-12-12 |
Last Update Date | 2024-02-12 |