| NPI | 1821417692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS JAY AUGUSTIAN Chief Executive Officer 920-405-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 29836) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-04-20 |