| NPI | 1215935218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0105X Surgery, Surgery of the Hand (Licence: WA MD00033630) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00033630) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2011-07-19 |