| NPI | 1235516642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON S NYKAZA Owner 815-513-3654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238.000280) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2015-05-05 |