| NPI | 1255179743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY WACKSMAN Authorized Official 855-232-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2024-07-18 |
| Last Update Date | 2024-07-18 |