| NPI | 1043615180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM R GALLIVAN President 805-220-6020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2015-10-08 |