| NPI | 1194093765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC A JOHNSON Owner 719-650-7994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO 99750) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2022-02-17 |