| NPI | 1710062492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00020104) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: WA MD00020104) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-01-23 |