| NPI | 1962624056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA FORSHEY Credentialing Manager 209-956-7725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2022-07-21 |