| NPI | 1043805690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIC BAGNOLI Chief Chair 844-474-4019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2025-06-16 |