| NPI | 1972277895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA M LEYNGOLD Medical Director 904-233-1269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2022-03-07 |