| NPI | 1073755443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEO RYO OTAKE Medical Director 203-752-0015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 046053) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2009-04-01 |