| NPI | 1215131099 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX n8806)  | 
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: TX N8806)  | 
| Enumeration Date | 2007-06-13 | 
| Last Update Date | 2019-01-23 |