NPI | 1801887500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 010138) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: LA MD.010138) |
Enumeration Date | 2005-11-02 |
Last Update Date | 2021-12-19 |