| NPI | 1265920565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE JAVON DENTON Certified Surgical First Assistant 918-361-7366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2018-04-23 |