| NPI | 1669247037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY GIAMBELLUCA Credentialing Specialist 985-313-1015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-16 |