| NPI | 1174396113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA GUALBERTO Administrative Officer 929-319-3404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |