| NPI | 1508394990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MARKS Manager 352-514-1524 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL OS14397) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2022-11-04 |