| NPI | 1982943726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JERNBERG Enrollment 469-401-2386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2014-01-24 |