| NPI | 1104609122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDEEP MANN Owner 209-851-2065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2024-12-03 |