NPI | 1720168958 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: FL OS3512) |
Additional Taxonomies | 208600000X Surgery (Licence: OH 34002298) |
2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX F2636) | |
Enumeration Date | 2006-10-16 |
Last Update Date | 2007-07-08 |