| NPI | 1093140022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL HICKS Authorized Representative 972-715-5044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-10-18 |