| NPI | 1427700798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER LAURENT President 971-678-2298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2022-01-20 |