| NPI | 1104440411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY J KENESON Owner 682-936-2544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2020-10-22 |