| NPI | 1194288100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWAYNE LOCKHART Owner 239-424-9846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207LA0401X Anesthesiology, Addiction Medicine | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-05-03 |