NPI | 1053612804 |
---|---|
Entity Type | Organization |
Authorized Contact | HENRY U ISIOCHA Physician 302-747-7903 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: DE C1-0005027) |
Additional Taxonomies | 305S00000X Point of Service (Licence: DE C1-0005027) |
Enumeration Date | 2010-11-10 |
Last Update Date | 2010-12-29 |