| NPI | 1235308099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA 201082) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: LA 201082) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: LA 201082) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2021-05-05 |