| NPI | 1972762581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 55305) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: CT 55305) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2016-08-11 |