| NPI | 1326044710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL M BOUSTANY Owner 304-343-7557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 10600) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 10600) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2020-08-22 |