| NPI | 1629385786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SUTPHIN Owner 307-362-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WY 3547A) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 166834-1025) |
| 208800000X Urology (Licence: CA G42452) | |
| 363A00000X Physician Assistant (Licence: WY WY192) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2010-09-09 |