| NPI | 1518313642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CHRISTOPHER WOOD Doctor 317-590-2957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IN 12012123A) |
| Enumeration Date | 2016-05-07 |
| Last Update Date | 2016-05-07 |