NPI | 1154557502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX T2218) |
Additional Taxonomies | 208600000X Surgery (Licence: IL 036.145422) |
Enumeration Date | 2009-05-29 |
Last Update Date | 2022-04-11 |