NPI | 1699903781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AL MD36097) |
Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME 123652) |
Enumeration Date | 2009-06-26 |
Last Update Date | 2020-01-03 |