| NPI | 1891764700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A79221) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A79221) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: CA A79221) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2021-07-20 |