| NPI | 1780259382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KIBEC COO/Practice Administrator 971-701-6839 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |