| NPI | 1336170257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRAKE ERIC BELLANGER Owner 225-819-0983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 11666R) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00017405) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-08-22 |