| NPI | 1730886888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY SHAW Practice Manager 267-361-0315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-02-09 |