| NPI | 1023405297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CHRISTIAN DOMANSKI President 703-596-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101257764) |
| 208200000X Plastic Surgery (Licence: VA 0101257764) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2023-07-18 |