| NPI | 1588404958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW DIESSELHORST Owner 405-463-3337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2024-05-31 |