| NPI | 1336200898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 142411) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 142411) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: NY 142411) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2010-11-15 |