| NPI | 1083365548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD JACOBY Owner 402-302-0023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-01-15 |
| Last Update Date | 2022-01-15 |