| NPI | 1114441565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA MORAN Credentialing Specialist 907-982-8674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2022-08-09 |