| NPI | 1164021945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN WEISS Owner 386-774-1881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| 208D00000X General Practice | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2020-10-22 |