| NPI | 1083106348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRISCILLA CHIU Intern 862-579-7877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2018-06-02 |
| Last Update Date | 2018-06-02 |