| NPI | 1164285557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEEGAN ZIEMBA Secretary 757-630-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-01-30 |