| NPI | 1295344810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER JOHN KOVANDA Sole Member 129-792-0936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-12-30 |