| NPI | 1881934685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER E BRUCK Owner 989-892-4591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2025-01-14 |