| NPI | 1033099775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA SHANKS Credentialing Specialist 725-235-7239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| 208100000X Physical Medicine & Rehabilitation | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-11-10 |