| NPI | 1558533935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA K CRITSER Credentialing Specialist 317-422-5490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IN 01029384A) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2008-06-11 |