| NPI | 1457610172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GOL Manager 904-265-6412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-05-15 |