NPI | 1639263676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 024863) |
Additional Taxonomies | 174400000X Specialist (Licence: GA 024863) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2015-06-22 |