| NPI | 1013530443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN DEGRAFT KOOMSON President 267-815-7307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-05-20 |