| NPI | 1518999135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX K4735) |
| Additional Taxonomies | 2086S0105X Surgery Surgery of the Hand (Licence: TX K4735) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-10-11 |