| NPI | 1255687778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL A INDILICATO Sole Member 480-596-8525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: AZ 4385) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |