| NPI | 1083028161 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0105X Surgery, Surgery of the Hand (Licence: MN 68099) | 
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301105284) | 
| Enumeration Date | 2014-06-17 | 
| Last Update Date | 2021-11-11 |