| NPI | 1962003210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA BUSH Credentialing Specialist 479-437-3449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RI0011X Internal Medicine Interventional Cardiology | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2023-04-21 |