| NPI | 1194078055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN KNUEVEN Credentialing Supervisor 567-585-1969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 208M00000X Hospitalist | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2023-10-04 |