| NPI | 1902109549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL RHEAD COTTAM Owner/Provider 855-655-7389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 6655906-1205) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2022-01-10 |