| NPI | 1053778845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BAILEY Credentialing Specialist 804-571-5106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101036726) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101257013) | |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2019-06-11 |