| NPI | 1033688932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA BLAIRE DANIEL Owner 225-802-1850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2021-11-10 |