| NPI | 1215033402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WV WV20534) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: WV 20534) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2011-06-08 |