| NPI | 1801561204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A205206) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: NY 308729-01) |
| 208200000X Plastic Surgery (Licence: NY 308729-01) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2025-12-04 |