| NPI | 1720649940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LOIDOLT Managing Physician 916-800-4685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-06-27 |