| NPI | 1912030479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A110114) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: OH 90268) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: OH 90268) | |
| 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: NY 241912-1) | |
| 208200000X Plastic Surgery (Licence: OH 90268) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-06-09 |