| NPI | 1285364182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHANGA YATAWATTA Owner 725-400-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery |
| 2086X0206X Surgery Surgical Oncology | |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-10-10 |