| NPI | 1366035982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERIK K KING Authorized Official 800-893-9698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2021-02-15 |