| NPI | 1114415528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE ANDRY WIJAY Managing Member 225-573-0479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX R5693) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-06-07 |