NPI | 1679751770 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK DAVID WIGOD President 208-377-9515 |
Organization Subpart ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ID M8189) |
Enumeration Date | 2008-01-31 |
Last Update Date | 2008-01-31 |