| NPI | 1114031853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WA MD00036994) |
| Additional Taxonomies | 2086S0105X Surgery Surgery of the Hand (Licence: WA MD00036994) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2008-02-21 |