| NPI | 1356714638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALI N WAZNI Chief Administration Officer 800-991-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2024-03-08 |