| NPI | 1952072761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIAN L STALLWORTH President 210-616-0301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery |
| Additional Taxonomies | 208200000X Plastic Surgery |
| 2086S0122X Surgery Plastic and Reconstructive Surgery | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-22 |