| NPI | 1679766943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME142276) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT 182598) |
| 208600000X Surgery (Licence: PA MT182598) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: TX N7546) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: GA 076607) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2020-08-18 |