| NPI | 1730150707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX G7853) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: TX G7853) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2019-08-08 |