| NPI | 1205411642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHENIE L PORIS Owner 407-558-1616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck |
| 208600000X Surgery | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2022-06-01 |