| NPI | 1568669273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301090381) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: OR MD160827) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2016-12-06 |