| NPI | 1548800980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALI N WAZNI Chief Administration Officer 800-991-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2025-04-25 |