| NPI | 1114477072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILE MANANSALA Pa C 602-717-6779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2356) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |