| NPI | 1487380069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK WILSON President 256-701-1991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-07-27 |