| NPI | 1558959015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER M ALLEN Owner 267-627-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-01-08 |