NPI | 1225212442 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A79125) |
Additional Taxonomies | 208600000X Surgery (Licence: CA A79125) |
2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60013998) | |
Enumeration Date | 2007-12-24 |
Last Update Date | 2019-04-02 |