| NPI | 1891442869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYAN LONG Billing Manager 843-224-8086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-10-06 |