| NPI | 1912393315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0105X Plastic Surgery Surgery of the Hand (Licence: TX Q3798) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WI 101165) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2023-12-04 |