| 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 |