| NPI | 1275805749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOSEPH RABORN Owner 870-275-6436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2019-01-14 |