| NPI | 1710095690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE SMITH Administrator 318-425-8701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: LA 09700) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-08-22 |