| NPI | 1194317834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB KETEYIAN President 488-911-2682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2022-06-17 |