| NPI | 1972977866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SCOTT HACKENBRUCH President 907-903-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 882) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2015-11-16 |