| NPI | 1154714673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN DAVIN HARAWAY Practitioner 918-706-2161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 3263) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2022-10-06 |