| NPI | 1487272647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58795) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA 58795) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2022-07-10 |