| NPI | 1922208164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX N0721) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD27611) |
| 2086S0105X Surgery, Surgery of the Hand (Licence: OR MD27611) | |
| 2086S0105X Surgery, Surgery of the Hand (Licence: WA MD60016651) | |
| 2086S0105X Surgery, Surgery of the Hand (Licence: TX N0721) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2016-05-10 |