| NPI | 1124458583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN REAGAN GRANT Owner 425-205-1305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: WA MD60187241) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2023-05-04 |