| NPI | 1053860841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BLASENAK Member 864-991-6156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 978) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 31430) |
| 207Q00000X Family Medicine (Licence: SC 19491) | |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |