| NPI | 1497486245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS KRAHN Owner/Provider 909-475-8611 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2022-06-22 |