| NPI | 1902812407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONET CHRISTOPHER MAIN Owner 660-385-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-12-01 |