Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 200000088 | NC |
NPI | 1043356868 |
---|---|
Provider Name | Dr. Tor Martin Ljung |
First Address | Wilmington, NC 28401-7307 |
Second Address | Wilmington, NC 28405-3175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 11/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89126PG | (05) | NC |
G93503 | (02) | NC |