| NPI | 1447390604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MERKOW Credentialing Mgr 277-800-9958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0040910) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0064414) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-08-28 |