| NPI | 1093281438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN DIANE HARRIS Credentialing Coordinator 540-960-1454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2021-08-23 |