| NPI | 1750471983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G9333) |
| Additional Taxonomies | 2082S0105X Plastic Surgery Surgery of the Hand (Licence: TX G9333) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-06-30 |