| NPI | 1104303346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 156424) |
| Additional Taxonomies | 2086S0105X Surgery, Surgery of the Hand (Licence: CA 156424) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA 156424) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2024-04-29 |