| NPI | 1043852569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LLATOYA GAYLE Credentialing Coordinator 475-210-5346 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2019-10-16 |