NPI | 1235517996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MT221196) |
Additional Taxonomies | 208600000X Surgery (Licence: RI LP03325) |
Enumeration Date | 2015-05-14 |
Last Update Date | 2020-06-25 |