| NPI | 1578934642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER C STREET Officer 401-688-0862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA 138470) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2016-02-23 |