| NPI | 1609264720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Lead 267-456-2634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2024-07-09 |