| NPI | 1902852130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA GROTH (AO) Credentialing 904-223-3321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 041205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 041205) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: GA 041205) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-06-27 |