| NPI | 1972566594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORAL FULLER Credentialing Manager 231-830-2729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2022-06-15 |