| NPI | 1891020566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW T. MOUNTAIN Authorized Official 386-575-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2009-11-05 |