| NPI | 1821259722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: AZ 50178) |
| Additional Taxonomies | 2082S0105X Plastic Surgery Surgery of the Hand (Licence: AZ 50178) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 50178) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2019-09-20 |