| NPI | 1215741509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOBIAS CHARLES LONG Ownder 484-824-3162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-09-19 |