| NPI | 1225173149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SCOT DAVIS Office Manager 302-856-3171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0006045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0006044) |
| 363A00000X Physician Assistant (Licence: DE C5-00000702) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2010-06-28 |