| NPI | 1487788824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY K MUCK Practice Manager 386-760-0915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME0027133) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME0044566) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2010-08-06 |