NPI | 1467587089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX R2779) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 25726) |
Enumeration Date | 2007-02-22 |
Last Update Date | 2022-05-24 |