| NPI | 1215157110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YUSR ABOUSHAAR Owner 304-925-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 18109) |
| 174400000X Specialist | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-05-01 |