| NPI | 1487792917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONET CHRISTOPHER MAIN Owner 660-385-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: MO 110583) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-09-23 |