| NPI | 1790002350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA 61182693) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 29120) |
| 208600000X Surgery (Licence: IA MD-47359) | |
| 2086S0105X Surgery, Surgery of the Hand (Licence: IA MD-47359) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WV 29120) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IA MD-47359) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA 61182693) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD61293744) | |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2024-04-30 |