| NPI | 1265209456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR MORAN CEO 765-284-7738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2023-12-07 |