| NPI | 1477971315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CLARY CEO 918-925-3224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2021-05-12 |