NPI | 1982265484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 94086) |
Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 57.248135) |
Enumeration Date | 2019-06-25 |
Last Update Date | 2025-09-02 |