| NPI | 1073793501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY CHARLES ROBERTSON Owner 410-836-7205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MD D0037409) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2013-03-14 |