NPI | 1649707506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10060963) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.148090) |
Enumeration Date | 2017-05-22 |
Last Update Date | 2024-11-06 |