NPI | 1164814612 |
---|---|
Entity Type | Organization |
Authorized Contact | RONALD A MARTIN Regional Director 757-962-0748 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201920) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 207QA0401X) |
Enumeration Date | 2015-02-20 |
Last Update Date | 2015-11-17 |