| NPI | 1295445179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON PALACIOS Credentialing Coordinator 877-940-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2022-12-01 |
| Last Update Date | 2023-03-31 |