| NPI | 1851170575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYLAN MIYAT Certified Surgical First Assistant 309-530-3407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2023-09-22 |