| NPI | 1104339902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFAN HARISKOV Co Treasurer 617-610-6801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2024-06-26 |