| NPI | 1922591320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN W GILLESPIE Owner 302-274-2996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DE C1-0012570) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2022-09-15 |