| NPI | 1164441101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID SCHWINDT Owner Provider 8605-720-0010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CT 0471821) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: RI MD11245) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-22 |