| NPI | 1104372507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRADEEP KHANNA Md/Credentialing 904-527-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN514) |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2016-08-27 |