| NPI | 1497755805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC 36150) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 58471) |
| 2082S0105X Plastic Surgery Surgery of the Hand (Licence: SC 36150) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: IL 036.118809) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NC 58471) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: IL 036.118809) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2018-11-16 |