| NPI | 1811594393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REIKO ADELE CASTEEN Surgical Assistant 757-636-7856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2021-06-11 |