| NPI | 1023724861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EAMON CHRISTOPHER POOR Office Manager 260-402-1503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2023-01-25 |