| NPI | 1073385431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZLYN GOFF Authorized Official/ Owner 321-321-6551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2023-11-21 |