| NPI | 1891136982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN MANIKATOV Registered Surgical Assistant 630-357-2464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2023-06-10 |