| NPI | 1649742321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN ARTIOLI Credentialing Specialist 843-234-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2024-04-25 |