| NPI | 1023697406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GABRIEL AZZAM Owner 913-906-8640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2021-12-24 |