| NPI | 1174121867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE DUA Ownwe 844-644-4325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2020-10-14 |