| NPI | 1821680471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN ERIC LARSON Cmo, CEO 520-771-0177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2021-02-05 |