| NPI | 1659790376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 129685) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: CA 129685) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2014-07-08 |