| NPI | 1972914596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MULLINS Owner 833-774-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 265787) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 261853) |
| 207L00000X Anesthesiology (Licence: NY 265787) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 261853) | |
| 207T00000X Neurological Surgery (Licence: NY 190377) | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2021-12-22 |