| NPI | 1861458705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 25551) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 25551) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: KY 25551) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-06-10 |