| NPI | 1679627566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BRENNER President 1907-452-7522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AK MD4599) |
| Additional Taxonomies | 208800000X Urology (Licence: AK MD4600) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-08-22 |