| NPI | 1245055151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DARIUS Billing Manager 424-728-7877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2025-02-20 |