| NPI | 1184091449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC K GROTEKE Member 855-266-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME 115180) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME107168) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |