| NPI | 1245501980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR P MORAN CEO 765-284-7738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000811A) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2022-11-29 |