| NPI | 1902123839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP GROSSMAN Authorized Official 304-270-7572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2011-10-07 |