| NPI | 1134599061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN L KENNAH Provider 907-644-6055 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: AK 103875) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2015-10-05 |