| NPI | 1760955355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE HETTMANN Provider Credentialing Coordinator 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2022-04-20 |