| NPI | 1578276556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN BRADY Owner 619-200-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-04 |