NPI | 1326205238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME135896) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101248740) |
2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 283325) | |
Enumeration Date | 2008-05-19 |
Last Update Date | 2022-05-11 |