| NPI | 1558197756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0121X Registered Nurse, Plastic Surgery (Licence: CA 740905) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: CA 740905) |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2024-09-12 |