| NPI | 1053818476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLE D STATEN Owner 614-402-1869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2019-12-17 |