| NPI | 1790960433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WI 21353020) |
| Additional Taxonomies | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: WI 21353020) |
| 2086S0105X Surgery Surgery of the Hand | |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2007-12-31 |