| NPI | 1063253490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY GOAD Owner 855-743-2247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2024-11-19 |