| NPI | 1306539226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAN J SHOCKLEY CEO/Owner 202-489-1125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2023-07-03 |