| NPI | 1366838864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX R6968) |
| Additional Taxonomies | 2086S0105X Surgery Surgery of the Hand (Licence: TX R6968) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 50213) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2019-01-02 |