| NPI | 1497128953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON DELP Delegated Official 904-874-7215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME107749) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2015-11-05 |