| NPI | 1508271263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WADE DORFMAN Owner 916-601-3457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A106340) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2019-01-24 |