| NPI | 1679942668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL PACKARD Owner 928-699-6786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2015-09-19 |
| Last Update Date | 2015-09-19 |