| NPI | 1083241988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER LEE TAICHER Chief Executive Officer And Cmo 857-210-3635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 133N00000X Nutritionist | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 208800000X Urology | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-03-23 |