| NPI | 1467076059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS E COSTA Owner 302-505-0045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2020-05-30 |
| Last Update Date | 2020-07-15 |