| NPI | 1598146888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS LARSEN Provider/Owner 307-638-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 76505701204) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2015-06-12 |