| NPI | 1891521308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEA JEANINE WALTON Manager 043-166-0817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RB0002X Internal Medicine, Bariatric Medicine |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-11-21 |