| NPI | 1417215351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0105X Plastic Surgery Surgery of the Hand (Licence: WA MD61343126) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA MD61343126) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2023-02-10 |