| NPI | 1386440535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER WAYMENT Member 208-421-2754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-02-25 |