NPI | 1811961113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 17174) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 17174) |
Enumeration Date | 2006-02-14 |
Last Update Date | 2025-04-29 |