| NPI | 1295784213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA ANN HERARD Practice Administrator 919-859-1886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 200201015) |
| Additional Taxonomies | 174400000X Specialist (Licence: ND 34590) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2010-08-25 |