| NPI | 1962070334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL E VERBIST Member/Manager 270-709-1984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-04-06 |